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For 30 years, politicians and health-care officials in Ontario have touted the benefits of home care. It’s convenient, allows seniors to live independently and saves the medical system billions of dollars.

A hospital bed costs an
average
of $842 a day. Home care costs an average of $42 a visit.

But there’s something missing from this rosy narrative. There are no safety standards for home care. What goes on in patients’ houses or apartments does not have to be documented or disclosed.

The researchers found that 10 to 13 per cent of home-care patients experience an “adverse event” — a serious fall, medication error or preventable infection — every year. (The comparable rate for
hospitals
is 3.3 to 5 per cent annually.)

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Safety at Home
is the first study of its kind. The researchers combed the records of home-care organizations across the country and filled in the gaps with statistical extrapolation. Their analysis showed that half of the home-care mishaps could have been prevented.

These findings substantiate what many families have been saying for years: Hospitals discharge frail, elderly patients without proper planning or adequate support.

Although the 36-page document is laden with academic/medical jargon, its charts and graphs are clear and its illustrations — cluttered apartments, table tops loaded with pill bottles, wheelchairs wedged between other pieces of furniture, cords and tubes everywhere — speak volumes.

The primary cause of preventable injuries and infections, the researchers concluded, is the ever-changing stream of support workers, nurses, therapists and supervisors trooping through the house. These home-care employees don’t have a common patient plan. They don’t keep consistent records. Communication is minimal or non-existent.

A secondary problem is that the packaging of pharmaceuticals and equipment varies, creating confusion and heightening the possibility of mistakes.

Independent-minded patients can also put their own safety at risk: moving pill bottles around, manoeuvring themselves into unstable positions, insisting caregivers attempt things for which they are not trained.

Some of these hazards — tiny apartments filled with cherished possessions, high turnover at home-care agencies, strong-willed patients — can’t be avoided. But most of them can be better managed with more forethought, teamwork and training.

The authors recommend that:

Every home-care patient be assigned a “quarterback” to make sure all caregivers — including family members — are fully briefed, moving in the same direction and up to the tasks required.

The province standardize patient charts and checklists and make them mandatory.

The
Ministry of Health
lift its arbitrary cap on the number of hours of home-care a patient can receive and loosen its bureaucratic rules (a patient can receive no more than two portable oxygen cylinders a month, for example).

Home-care professionals keep a close eye on family caregivers. They carry most of the burden, yet many are in failing health themselves. Forgetfulness, depression and burnout are common.

Three of the four can be done without increasing spending. All are straightforward and feasible.

Health Minister
Deb Matthews
never mentions safety in her upbeat speeches about “comfortable, dignified, convenient” care in the home. Her
blueprint
for the province’s health-are system contains no reference to it. The quality of care varies with the local
Community Care Access Centre
allocating it and the home-care agencies delivering it.

The minister admits there is a severe shortage of home care in Ontario. Her government has earmarked an additional
$700 million
to home care — $260 million this year.

More money will certainly help. But two other ingredients are imperative for a safe, patient-centred home-care system: strong leadership and constant vigilance.

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